Melissa Klein Cutshaw

Background: Bolivia has one of the highest burdens of Chagas disease. Transmission is most common through the triatomine bug vector carrying Trypanosoma cruzi infection, but a rising proportion of cases occurs through congenital transmission from mother to infant. Women living in endemic regions with high vector circulation are known to have an elevated risk of Chagas disease, but the relative risk of congenital transmission is unclear. Methods: We performed a prospective observational study of pregnant women with Chagas disease and their infants at 11 hospitals in Bolivia from September 2020 to March 2023. High vector circulation zones were defined as having triatomine infestation in >3% of local homes. Congenital Chagas disease was diagnosed in infants using polymerase chain reaction (PCR) at birth, micromethod at birth and 1 month, or serology at 9 months. Results: We enrolled 238 pregnant women, with a mean age of 28.7 years; 139 (58.4%) lived in high vector circulation areas. Of these, 19 women delivered infants who tested positive for T. cruzi infection (transmission rate 8.0%). Infants with congenital Chagas disease were significantly more likely to require hospitalization after birth (21.1% vs. 5.8%, p = 0.013). Women living in high vector circulation areas were more likely to have homes with mud walls (p < 0.001) and thatched roofs (p < 0.001) and to report having seen triatomine bugs in their home (p = 0.001). Congenital transmission rates did not significantly differ between women from low or high vector circulation zones (10.1% [9 of 139] vs. 6.5% [10 of 99], p = 0.31). Conclusions: Congenital transmission of Chagas disease remains common through multiple regions of Bolivia, regardless of local vector circulation control, and is associated with markedly higher rates of infant hospitalization after birth.

Workers in food processing industries are subject to many occupational health risks and disparities, but little is known about their risk of tickborne diseases. We examined a cohort of Latino individuals working in the meat packing, produce processing, and farming industries and their family members in central North Carolina, where incidence of tickborne infections is high. Blood samples were tested for IgG antibodies against Spotted Fever Group Rickettsiosis (SFGR) and Ehrlichia chaffeensis. Covariates of interest included age, sex, primary language, work industry, indoor vs. outdoor work, home characteristics, medical comorbidities, and travel history. Among 201 Latino food processing workers and their family members, the seroprevalence of SFGR and Ehrlichia was 14.9% and 19.9%, respectively. Almost a third of participants were seropositive for at least one infection. SFGR seropositive individuals were significantly older than seronegative individuals (median 45 [interquartile range 35–55] vs. 33 [14–45] years, p < 0.001), while Ehrlichia seropositivity appeared to have a bimodal distribution by age, with peaks in children under age 10 and adults in their forties and fifties. Farm workers had higher seroprevalence of SFGR (25.0%) than other workers (13.5%), although this did not reach statistical significance (p = 0.13). Having a seropositive household member for either infection was a risk factor for seropositivity for the same infection, adjusted for age and household clustering (adjusted OR [aOR] 8.26, 95% CI [confidence interval] 3.27-20.90 for SFGR; aOR 11.24, 95% CI 4.24-29.80 for Ehrlichia). Seroprevalence for SFGR and Ehrlichia was similar between index workers and household members when adjusted for age. Our findings indicate that Latino food processing communities in North Carolina have high exposure to tickborne disease, and older age and having seropositive household members are key risk factors.

People with HIV are at increased risk of cardiovascular events; thus, care delivery strategies that increase access to comprehensive cardiovascular disease (CVD) risk management are a priority. We report the results of a multi-component telemedicine-based strategy to improve blood pressure control among people with HIV-Assess and Adapt to the Impact of COVID-19 on CVD Self-Management and Prevention Care in Adults Living with HIV (AAIM-High). The AAIM High strategy is a virtual adaptation of our previously published EXTRA-CVD strategy and consisted of hypertension education and six components: nurse-led care coordination (delivered by teleconference or telephone), home systolic blood pressure (SBP) monitoring, evidence-based treatment algorithms, electronic health records tools, technology coach, and communication preferences assessment. People with HIV (n = 74) with comorbid hypertension at three academic medical centers were enrolled in a single arm implementation study from January 2021 to December 2022. Over 12 months, the average patient-performed home SBP decreased by 7.7 mmHg (95% CI -11.5, -3.9). The percentage of patients at treatment goal, defined as average SBP <130 mmHg, increased from 46.0% to 72.5% at 12 months. By adapting to the growing use of telemedicine in healthcare delivery, our study effectively improved hypertension control in people with HIV through a virtual, nurse-led intervention.

Background: Weight gain associated with integrase strand transfer inhibitors (INSTIs) is well documented. However, recent reports suggest that the observed weight gain among persons who switch to INSTIs may be associated with their preswitch regimen. Methods: We conducted retrospective analyses of persons with HIV on antiretroviral therapy who switched to a second-generation INSTI–containing regimen (bictegravir/dolutegravir) at the Duke Adult Infectious Diseases Clinic (Durham, NC, USA) between 2014 and 2021. The outcome was weight change, operationalized as percent weight change, absolute weight change (kg), gaining ≥5% of preswitch weight, and gaining ≥10% of preswitch weight. The primary exposure was preswitch regimen. Results: Our analysis included 750 persons. Cohort demographics were as follows: mean age (SD) 51 (11) years, 30% female at birth, 58% Black, 4% Hispanic ethnicity. At regimen switch, the mean CD4 count was 701 cells/mm3, and 68% had a viral load ≤20 copies/cc. Persons with preswitch regimens containing efavirenz had higher odds of gaining ≥5% body weight (odds ratio [OR], 1.62, 95% CI, 1.13–2.32) and ≥10% body weight (OR, 1.68; 95% CI, 1.02–2.73) after regimen switch, adjusted for age, sex, race, ethnicity, and preswitch body mass index. Persons with preswitch regimens containing tenofovir disoproxil (TDF) also had higher odds of gaining ≥5% body weight (OR, 1.64; 95% CI, 1.17–2.30). Conclusions: Preswitch regimens containing efavirenz and TDF were associated with significant weight gain after switching to INSTI-based regimens. Our findings support the hypothesis that the weight gain observed with switching to INSTI-based regimens could be driven by stopping medications with weight-suppressing properties.

Meat packing, produce processing, and farm workers are known to have an elevated risk of COVID-19, but occupational risk factors in this population are unclear. We performed an observational cohort study of meat packing, produce processing, and farm workers in North Carolina in fall 2020. Blood, saliva, and nasal turbinate samples were collected to assess for SARS-CoV-2 seropositivity. Risk factors for SARS-CoV-2 seropositivity were investigated using chi-square tests, two-sample t-tests, and adjusted risk ratio analyses. Among 118 enrolled workers, the baseline SARS-CoV-2 seroprevalence was 50.0%. Meat packing plant workers had the highest SARS-CoV-2 seroprevalence (64.6%), followed by farm workers (45.0%) and produce processing workers (10.0%), despite similar sociodemographic characteristics. Compared to SARS-CoV-2 seronegative workers, seropositive workers were more likely to work in loud environments that necessitated yelling to communicate (RR: 1.83, 95% CI: 1.25–2.69), work in cold environments (RR: 1.58, 95% CI: 1.12–2.24), or continue working despite developing symptoms at work (RR: 1.63, 95% CI: 1.14–2.32). After adjusting for age and working despite symptoms, high occupational noise levels were associated with a 1.72 times higher risk of SARS-CoV-2 seropositivity (95% CI: 1.16–2.55). Half of food processing workers showed evidence of past SARS-CoV-2 infection, a prevalence five times higher than most of the United States population at the time of the study. Work environments with loud ambient noise may pose elevated risks for SARS-CoV-2 transmission. Our findings also highlight the disproportionate burden of COVID-19 among underserved and economically disadvantaged Latinx communities in the United States.

Although cardiovascular death is a growing source of mortality for people living with human immunodeficiency virus (HIV), the risk factors and circumstances surrounding sudden death in this population are poorly understood. We compared 399 adult sudden death victims reported by Emergency Medical Services in North Carolina to 1,114 controls. Sudden death was more common among HIV-positive than HIV-negative individuals (OR: 2.59, 95% CI: 1.15–5.83). In a multivariable model of sudden death victims including Black race, BMI, and history of divorce, incarceration, substance abuse, and respiratory disease, HIV-positive individuals were more likely to be Black (adjusted OR [aOR]: 6.04, 95% CI: 1.08–33.7) or divorced (aOR: 4.71, 95% CI: 1.04–21.3), adjusted for all other variables in the model. Compared to controls with HIV, sudden death victims with HIV were more likely to have a history of incarceration, divorce, respiratory disease, alcohol abuse, or dyslipidemia. A qualitative assessment of victims suggested that many died in isolation, suffering from past and current substance abuse and depression. HIV infection appears to be an important risk factor for sudden death, and incarceration history, social isolation, and medical comorbidities contribute to sudden death risk for HIV-positive individuals.